Healthcare Provider Details

I. General information

NPI: 1003747536
Provider Name (Legal Business Name): WILLOW AND SAGE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 PACE ST
SMITHFIELD NC
27577-3112
US

IV. Provider business mailing address

316 PACE ST
SMITHFIELD NC
27577-3112
US

V. Phone/Fax

Practice location:
  • Phone: 252-933-9671
  • Fax: 252-933-9671
Mailing address:
  • Phone: 252-933-9671
  • Fax: 252-933-9671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEANENE MCBRIDE
Title or Position: OWNER
Credential: MBA
Phone: 252-933-9671